Promising screening research for ovarian cancer

In Delaware, 343 women were diagnosed with the disease from 2003 to 2007, which is only represents 3.1 percent of all cancers diagnosed in women for that time period. But 214 women died.(Photo: Getty Images)

Dorianne Short had been feeling uncomfortable chronic abdominal and back pain consistently for 18 months.

By the time she turned 50, doctors finally had diagnosed her with uterine fibroids, growths that develop from uterine tissue, and scheduled surgery to remove them.

But when her doctor began the surgery, her physician immediately stopped when she saw that the root of the problem was not fibroids, but stage two ovarian cancer.

"I waited four hours on the table for the gynecological oncologist to do the surgery," Short recalled. She had to have a hysterectomy to remove her ovaries and uterus and later had eight five-hour chemotherapy treatments.

"I'm lucky," said Short, now 64 and cancer-free for more than 10 years. "Mine conceivably could have progressed to stage four by the time I was diagnosed."

Ovarian cancer is the most deadly of the female reproductive system cancers, according to the American Cancer Society. It's also relatively uncommon.

The most recent state data shows that in Delaware from 2005 to 2009, 314 women were diagnosed with the disease and 217 died from it. But that number only represents 2.7 percent of all cancers diagnosed in women at that time.

The disease begins in a woman's egg-producing ovaries and often spreads throughout the entire reproductive system and pelvis.

There is no specific test to screen for the disease, but area scientists and clinicians are now studying the genetic mutations that cause cancer with the hope that the research will lead to a way to detect tumors earlier.

In collaboration with the Wistar Institute, a freestanding National Cancer Institute-designated center in Philadelphia, Christiana Care Health System is studying cancer-causing proteins in tissues collected from patients.

Bolstered by a $100,000 grant from the Delaware Ovarian Cancer Foundation, the goal is to build a robust ovarian tissue database, said Dr. Stephanie Jean, director of gynecologic oncology research at Christiana Care.

"It’s a real need," Jean said. "But there isn’t anything right now that I'm aware of that makes a big difference in screening."

Due to lack of early detection and misdiagnosed symptoms, only about 20 percent of ovarian cancers are found at stage one or two. If the cancer is found later, the five-year survival rate can be below 30 percent.

Unlike ways to detect breast cancer, which can include a breast exam, mammography or biopsy, there is no simple physical screening test for ovarian cancer. An ultrasound can uncover cancer spots, but not well enough to be guaranteed. A pap test, which can detect abnormal cervical cancers cells, cannot show ovarian cancer.

Currently there are two approved tests that show cancerous proteins, CA 124 and HE4, in ovarian cancer patients, but David Speicher, a scientists with the Wistar Institute, said they are not reliable enough for early diagnosis.​

Speicher said there is a "one in a billion type of difference between your high abundance proteins and your proteins that are going to be good biomarkers."

Scientists want to create new biomarker tests that can be used in combination with the current models to improve early diagnosis rates

Ideally a simple blood test could be used in screening or perhaps a Pap smear could expand to test for ovarian cancer cells. Ovarian cancer tumor cells can be shed into the vaginal canal, Jean explained.

"It's all so very new. It’s a very exciting area of research now, but too early to say what it will actually produce in the end," she said.

Challenges in detecting

The American Cancer Society estimates that in 2016 22,280 women in the United States will be diagnosed with ovarian cancer and 14,240 will die from it.

Even though about 15 percent of ovarian cancers are related to the BRCA 1 and 2 breast cancer genes, there are four different subtypes of ovarian cancer and each differ genetically.

"I think part of it is these are very smart tumors," Jean said. The cancer's major symptoms often are not seen as indicating a serious illness.

Dorianne Short often felt tired and had trouble eating meals, but she chalked it up to being on a Weight Watchers program.

"It wasn’t something I could definitely pinpoint." she said. Now president of the Delaware Ovarian Cancer Foundation, she tries to raise awareness of the symptoms and new initiatives through 5Ks, fundraisers and health fairs and by turning towns teal in September for ovarian cancer education.

Sherry Pollex, girlfriend of NASCAR driver Martin Truex Jr., also turned her diagnosis into an awareness platform. Pollex was diagnosed with stage 3 ovarian cancer in August of 2014 at age 35.

She felt bloated and had severe pelvic pain, but doctors could not locate the cause, diagnosing her with conditions such as ovarian cysts, celiac disease or irritable bowel syndrome.

Finally the pain was so bad, a friend who was a gastroenterologist offered to do a CT scan on her entire body to see if there was an underlying issue. Thirty minutes later her friend was in tears, she said, as he explained that ovarian cancer had spread to her pelvic area. He gave her until Christmas.

"Cancer never even crossed my mind," she said from Dover when Truex was competing at the Dover International Speedway in May. "That day my life changed forever. It's so shocking. I was trying to get pregnant."

She has a 13-inch scar from her rib cage to pubic bone where doctors removed her ovaries, uterus and scrapped cancer cells off her spleen and diaphragm. Then she had 17 straight months of chemotherapy.

"You know when something is wrong with your body," Pollex said. "I can't emphasize that enough. Do your research and ask questions."

Now Pollex advocates for a test called the Ova1.

Though not a screening test, it can detect whether a pelvic mass is benign or cancerous. It is covered by Medicare and some insurance companies, but patients would have to pay $295 if it is not approved.

The test helps refer women to a gynecological oncologist for surgery if the mass is cancerous, said Dr. Judy Wolf, chief medical officer of Vermillion, the manufactor of the Ova1 test.

Wolf, formerly a professor of gynecologic oncology at The University of Texas MD Anderson Cancer Center, added that being seen by a gynecological oncologist will improve a woman's survival rate by 40 percent. Tumors are not always easily found and it is difficult to discern normal tissue from a malignant mass.

"Unfortunately there's many places along the path to diagnosis and treatment when women with ovarian cancer are failed," she said.

Jen Rini can be reached at (302)324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.